Title : Ischemic stroke in the context of the COVID-19 pandemic: Comorbidities and in-hospital complications affecting the outcomes of ischaemic stroke patients
Abstract:
Stroke is ranked as the second major cause of death and a major cause of disability in the world with increasing annual numbers. Ischemic stroke (IS) being the most prevalent form of stroke, the role of COVID-19 in the risk of complications and outcomes for patients with IS is still important to explore. The aim of this retrospective record-based observational descriptive study was to evaluate the risk of in-hospital lethality for IS patients according to comorbidities, and in-hospital complications in the context of the COVID-19 pandemic.
Methods:
We identified 1898 acute IS patients (749 men and 1149 women), admitted to the Kaunas Hospital of the Lithuanian University of Health Sciences (Kaunas Hospital of LUHS), Lithuania, from December 2020 to February 2022. The sociodemographic, clinical, and outcome features of the patients were evaluated. T-test and ANOVA analysis with Bonferroni multiple comparison tests for interval data were used, a chi-squared test and z-test with Bonferroni corrections for categorical variables were deployed. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by the Cox proportional hazards regression for hospital lethality.
Results:
In-hospital lethality rates for IS patients were determined to be 15.0% in men and 19.7% in women (p<0.05). In men, suffering from IS and comorbid with chronic ischaemic heart disease (IHD), the risk of in-hospital lethality was 2.22 times higher compared to those, comorbid with isolated arterial hypertension (AH) (p<0.05). COVID-19 infection 3.16 times elevated the risk of in-hospital lethality in men (p<0.05). In women, comorbid with type 2 diabetes mellitus (DM) or chronic IHD, the risk of in-hospital lethality was 2 times higher compared to those, comorbid with AH (p<0.05). The risk of in-hospital lethality significantly increased in both men, and women, with an increase in the total number of in-hospital complications per 1 unit (HR=3.54 (95% CI 2.7-4.58) and HR=1.96 (95% CI 1.71-2.25), respectively).
Conclusions:
Of the comorbidities studied, DM and chronic IHD together with SARS-CoV-2 infection, elevated the risk of in-hospital lethality significantly. Within the acute in-hospital complications, pneumonia, respiratory failure, and acute renal failure showed the most significant prognostic value anticipating lethal outcomes for IS patients.
Audience Take Away
- Clinicians responsible for the management of the ischemic stroke (IS) patients always encounter versatile comorbid conditions and threatening in-hospital complications. The audience will get the insight how to evaluate their significance to the outcomes of IS patients
- The attenders will experience which of the comorbidities and acute in-hospital complications are of greatest prognostic value anticipating pour outcomes of IS patients
- We will present the role of COVID-19 and the specific vaccination to the clinical presentations of IS
